Assessment of the Aortic Root Using Real-Time 3D Transesophageal Echocardiography

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ecause of the rapid increase in cases of calcific aortic stenosis (AS) in industrialized countries, there are increasing numbers of symptomatic elderly patients who do not undergo aortic valve surgery because the surgical intervention poses significant risks related to coexisting comorbidities. 1,2 As a result, there are growing concerns regarding the poor prognosis of these patients and the increased associated medical costs. 3 Transcatheter aortic valve implantation (TAVI) has recently emerged as an alternative to surgery in high-risk patients with AS. 4-7 Detailed anatomical information regarding the aortic root geometry is important for selecting candidates for successful TAVI while avoiding associated complications. Recent studies have reported that multidetector computed tomography (MDCT) provides 3-dimensional (D) morphological information on the geometry of the aortic root, as well as the spatial relationship between the aortic annulus and the ostia of the left and right coronary arteries (LCA and RCA, respectively). 8-11 However, because of its known limitations, MDCT cannot be performed in all patients.Real-time 3D transesophageal echocardiography (3DTEE) has the potential to provide 3D information regarding aortic root morphology. We hypothesized that real-time 3DTEE could be a useful alternative for assessing aortic root geometry. Accordingly, the aims of this study were: (1) to validate 3DTEE measurements of aortic root using MDCT measurements as a reference, and (2) to examine whether the aortic root geometry differs between patients with and without AS. Methods Study PopulationProtocol 1 We retrospectively enrolled 35 patients referred for MDCT coronary angiography who underwent Background: Precise evaluation of the aortic root geometry prior to transcatheter aortic valve implantation is important for procedural success in patients with aortic stenosis (AS). To determine the potential for 3-dimensional transesophageal echocardiography (3DTEE), the aims of the present study were: (1) to assess the accuracy of 3DTEE measurements of the aortic root using multidetector computed tomography (MDCT) as a reference, and (2) to examine whether aortic root geometry differs between patients with and without AS.

Percutaneous Valved Stent Implantation Above the Coronary Ostia - A New Transitional Treatment for Acute Aortic Valve Rupture -

“…In addition, the procedure is simple. 15 The results of the present study indicate the simplicity of valved stent implantation above the coronary ostia. The stent designed for the experiment was braided with super elastic nickel-titanium alloy wires, which allowed the stent to comply better and to attach to the aortic wall easily.…”

Dynamics of the Left Ventricular Outflow Tract during the Cardiac Cycle Assessed (with) Via Tridimensional Echocardiography

“…Otani et al [5] have reported a very good correlation between these two methods to assess the planimetric area of the outflow tract (r=0, 96 mean diference: 0.35 ± 0.29 cm ). This method would also allow modifying the continuity formula regularly used in the estimation of the aortic valve area (AVA).…”

“…We can add that not always the bi dimensional cut passes through the central LVOT axis which is another source of potential error [2]. At present, different studies have confirmed that LVOT anatomy is more elliptic than circular; a significant decrease of the estimated LVOT area related to the area measured by planimetry [3][4][5][6] is also observable. This contributes to underestimate both larger and smaller LVOT diameters, which are essential for the correct choice of percutaneous prosthesis, increasing the risk of perivalvular leaks, and prosthesis migration, among other complications [7].…”

Morphological Determinants of Obstructive Hypertrophic Cardiomyopathy Obtained Using Echocardiography

“…However, information obtained from both three-dimensional transesophageal echocardiography and multidetector computed tomography has shown that LVOT shape is not round but elliptical. 36,37) Thus, the 2D longaxis view does not always depict the longest span of LVOT, resulting in an underestimation of its full diameter. Limitations: The present study had several limitations.…”